Provider Demographics
NPI:1124210463
Name:WILLIAMS, ELLA MAE (MD)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:MAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLA
Other - Middle Name:WILLIAMS
Other - Last Name:WESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-590-8761
Mailing Address - Fax:214-590-1491
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-590-8761
Practice Address - Fax:214-590-1491
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK23852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00706281OtherRAILROAD MEDICARE
TX043439103Medicaid
TX043439104OtherCSHCN
TX8X5118OtherBCBS
TX8L2075Medicare PIN
TX8X5118OtherBCBS